Mental Health: A Report of the Surgeon General

Mental Health: A Report of the Surgeon General
Other Mental Disorders in Children and Adolescents
Because autism is a severe, chronic developmental disorder, which results in significant
lifelong disability, the goal of treatment is to promote the child’s social and language
development and minimize behaviors that interfere with the child’s functioning and
learning. Intensive, sustained special education programs and behavior therapy early in
life can increase the ability of the child with autism to acquire language and ability to
learn. Special education programs in highly structured environments appear to help the
child acquire self-care, social, and job skills. Only in the past decade have studies shown
positive outcomes for very young children with autism. Given the severity of the
impairment, high intensity of service needs, and costs (both human and financial), there
has been an ongoing search for effective treatment.
Thirty years of research demonstrated the efficacy of applied behavioral methods in
reducing inappropriate behavior and in increasing communication, learning, and
appropriate social behavior. A well-designed study of a psychosocial intervention was
carried out by Lovaas and colleagues (Lovaas, 1987; McEachin et al., 1993). Nineteen
children with autism were treated intensively with behavior therapy for 2 years and
compared with two control groups. Followup of the experimental group in first grade, in
late childhood, and in adolescence found that nearly half the experimental group but
almost none of the children in the matched control group were able to participate in
regular schooling. Up to this point, a number of other research groups have provided at
least a partial replication of the Lovaas model (see Rogers, 1998).
Several uncontrolled studies of comprehensive center-based programs have been
conducted, focusing on language development and other developmental skills. A
comprehensive model, Treatment and Education of Autistic and Related Communication
Handicapped Children (TEACCH), demonstrated short-term gains for preschoolers with
autism who received daily TEACCH home-teaching sessions, compared with a matched
control group (Ozonoff & Cathcart, 1998). A review of other comprehensive, centerbased programs has been conducted, focusing on elements considered critical to schoolbased programs, including minimum hours of service and necessary curricular
components (Dawson & Osterling, 1997).
The antipsychotic drug, haloperidol, has been shown to be superior to placebo in the
treatment of autism (Perry et al., 1989; Locascio et al., 1991), although a significant
number of children develop dyskinesias as a side effect (Campbell et al., 1997). Two of
the SSRIs, clomipramine (Gordon et al., 1993) and fluoxetine (McDougle et al., 1996),
have been tested, with positive results, except in young autistic children, in whom
clomipramine was not found to be therapeutic, and who experienced untoward side
effects (Sanchez et al., 1996). Of note, preliminary studies of some of the newer
antipsychotic drugs suggest that they may have fewer side effects than conventional
antipsychotics such as haloperidol, but controlled studies are needed before firm
conclusions can be drawn about any possible advantages in safety and efficacy over
traditional agents.